Current evidence on the safety and efficacy of fetal cystoscopy for the diagnosis and treatment of lower urinary outflow tract obstruction is not adequate for this procedure to be used without special arrangements for consent and for audit or research.
Clinicians wishing to undertake fetal cystoscopy for diagnosis and treatment of lower urinary outflow tract obstruction should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that the parents understand that the efficacy of the procedure is unproven and that the safety of the procedure is unknown. Clinicians should provide parents with clear written information. Use of the NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having fetal cystoscopy for diagnosis and treatment of lower urinary outflow tract obstruction (see section 3.1).
This procedure should only be performed in centres specialising in invasive fetal medicine and in the context of an appropriate multidisciplinary team, which should usually include a consultant in fetal medicine, a paediatric urologist, a neonatologist and a specialist midwife.
Further evidence is required, particularly in relation to appropriate case selection and outcomes. Reports should separate diagnostic cystoscopy from cystoscopy used with therapeutic procedures. NICE may review the procedure upon publication of further evidence.